than diastolic blood pressure, as
a major risk factor for cardiovas-
cular disease in people older than
50 years. As we age, systolic blood
pressure tends to rise due to
increasing stiffness of large arter-
ies, plaque buildup, and increased
incidence of cardiac and vascular
disease.
Management of
Hypertension with
CAD
Management of hyper-
tension in patients with
chronic CAD focuses
on the prevention of
death, heart attack, and
stroke; the reduction
of myocardial ischemia
(reduced blood flow
to the heart); and the
improvement of symp-
toms. This is accom-
plished with lifestyle
modifications and medi-
cation therapy.
Blood Pressure Targets in
Patients with CAD
The AHA/ACC/ASH guidelines
emphasize that although a tar-
get of less than 140/90 mm Hg is
reasonable to avoid heart attacks
and strokes, a lower target of
less than 130/80 mm Hg may be
appropriate in some individu-
als with heart disease who have
already experienced a stroke,
heart attack, or mini-stroke (also
called a transient ischemic attack)
or who have other cardiovascular
conditions, such as a narrow-
ing of leg arteries or abdominal
aortic aneurysm. In patients with
coronary artery blockages, the
guidelines recommend that blood
pressure should be lowered slowly
and that in patients older than
60 years, diastolic blood pressure
less than 60 mm Hg is not rec-
ommended because it raises the
potential for cardiovascular risk.
The guidelines issued by the 3
medical organizations offer spe-
cific, evidence-based recommen-
dations to help clinicians select
anti-hypertensive medications
for use in patients with various
types of heart disease. Several
drugs are available for the treat-
ment of hypertension, although a
beta-blocker is likely suitable for
most patients with CAD, by itself
or in combination with other
classes of drugs. In
addition to their effect
on blood pressure,
beta-blockers relieve
stress on the heart by
slowing the heart rate
and reducing the force
with which the heart
muscle contracts, both
of which reduce the
heart's consumption
of oxygen. They also
increase blood flow to
the heart by prolong-
ing the time between
contractions, which is
when blood flows into
the heart muscle.
Although medications are a
mainstay of treatment, the new
guidelines also recognize the
importance of lifestyle modifica-
tions such as smoking cessation,
weight loss, reduced sodium
intake, exercise, healthy diet, and
moderation of alcohol consump-
tion in those who drink.
n
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Coronary
arteries are
the major
blood vessels
that supply
the heart
with blood,
oxygen, and
nutrients.
How do you treat hyper-
tension? Tweet about it
@Pharmacy_Times
TABLE: HIGHLIGHTS OF THE NEW
HYPERTENSION TREATMENT
GUIDELINES
The American Heart Association, the
American College of Cardiology, and the
American Society of Hypertension have
issued a joint statement on treating high
blood pressure in people who have been
diagnosed with coronary heart disease,
stroke, or other forms of heart disease.
The statement reinforces the goal of reduc-
ing blood pressure to under 140/90 mm Hg
in order to reduce the risk of heart attack
and stroke.
Patients should know their blood pressure,
make lifestyle changes to reduce their risk
of heart attack and stroke, and work with
a physician to safely lower their blood pres-
sure
RESOURCES
Rosendorff C, Lackland DT, Allison M, et
al; American Heart Association; American
College of Cardiology; American
Society of Hypertension. Treatment of
hypertension in patients with coronary
artery disease: a scientific statement
from the American Heart Association,
American College of Cardiology, and
American Society of Hypertension. J Am
Soc Hypertens. 2015;9(6):453-498. doi:
10.1016/j.jash.2015.03.002.
New recommendations for treating
patients with high blood pressure and
cardiovascular disease, American Heart
Association Scientific Statement [press
release]. Dallas, TX: American Heart
Association; March 31, 2015. http://
newsroom.heart.org/news/new-recom-
mendations-for-treating-patients-with-
high-blood-pressure-and-cardiovascular-
disease?preview=0a76. Accessed October
22, 2015.
Understanding blood pressure readings.
American Heart Association website.
heart.org/HEARTORG/Conditions/
HighBloodPressure/AboutHighBlood
Pressure/Understanding-Blood-Pressure-
Readings_UCM_301764_Article.jsp#.
VibR4NaJlEc. Updated October 22, 2015.
Accessed October 22, 2015.
Mayo Clinic Staff. Coronary artery dis-
ease. Mayo Clinic website. mayoclinic
.org/diseases-conditions/coronary-artery-
disease/basics/definition/con-20032038.
Accessed October 22, 2015.
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